Abstract 4139258: Aspirin vs Clopidogrel as a Monotherapy secondary prevention in Patients with Coronary Artery Disease: An updated Meta-Analysis

Introduction: Antiplatelet therapy plays a significant role in the management of patients with coronary artery disease (CAD) to prevent cardiovascular events. Current guidelines recommend 6-12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) followed by either aspirin or clopidogrel monotherapy indefinitely. Previous meta-analyses have suggested a potential superiority of clopidogrel over aspirin. However, given the evolving landscape of cardiovascular medicine, there is a need for updated evidence to inform clinical practice. Hypothesis: This systematic review and meta-analysis, to our knowledge the most up-to-date, aims to compare the effectiveness and safety of aspirin versus clopidogrel as monotherapy in patients with coronary artery disease (CAD). Methods: We searched PubMed, Embase, and Cochrane Library databases for relevant randomized controlled trials (RCTs) and Non (RCTs) Studies published up to April 2024. The primary outcomes were Major Adverse Cardiovascular and Cerebrovascular Events, myocardial infarction, stroke, and Death, while secondary outcomes included major bleeding events, target vessel revascularization, repeated revascularization, and stent thrombosis. heterogeneity analysis, and pooled analysis conducted by RevMan 5.3 software. Results: A total of eleven (11) studies involving 26324 patients, of whom 11435 (43.4%) received clopidogrel met the inclusion criteria. Mean follow-up was 12-36 months. Duration of DAPT before antiplatelet monotherapy was 1-18 months. The meta-analysis revealed a significant reduction with Clopidogrel monotherapy in all the following compared to Aspirin monotherapy; myocardial infarction [ 0.77 -95%CI -(0.64 - 0.93)], stroke [ 0.59 -95%CI- (0.48 - 0.74)], major bleeding events [ 0.66 -95%CI- (0.53 - 0.84)], and repeated revascularization [ 0.88 - 95% CI ( 0.77 - 0.99 )]. There was no significant difference in the risk of major adverse cardiovascular and cerebrovascular events, death and cardiac death. Conclusion: Clopidogrel monotherapy may be associated with a lower risk of major bleeding, MI, stroke and repeated revascularization compared to aspirin monotherapy in patients with CAD. This supports the use of clopidogrel over aspirin in patients with CAD who require secondary prevention with long-term antiplatelet monotherapy.